My Doctor Online The Permanente Medical Group

Causes and Risk Factors

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Smoking is a major cause of COPD. We do not fully understand what causes COPD. While many factors may increase your risk of developing COPD, about a fifth of people with the condition have no known risk factors.

Common risk factors include: 

• Smoking. Smoking tobacco or marijuana increases your risk. Most people with COPD are smokers.
• Genetics. History of COPD in your family can increase your risk for developing COPD.
• Exposure to environmental agents or to secondhand smoke. 
• Allergies. Allergies to hay fever, grass, tree pollen, and/or house dust can increase your risk.
• Preterm birth is associated with newborn chronic lung disease, also known as bronchopulmonary dysplasia.

Prevention

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Here are steps to take to reduce your risk of COPD:

• Avoid smoking tobacco or marijuana or secondhand exposure to both.
• Avoid exposure to dust, gases, or fumes.
• Get physical exercise.

Symptoms

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The symptoms of COPD vary. Some people may have no symptoms, and we may find COPD during a routine chest X-ray or with other tests. Others may not recognize symptoms because they do not exercise enough to cause shortness of breath.

Common symptoms of COPD include:

• Shortness of breath, usually with exercise, at the onset of COPD. It can worsen over time so that shortness of breath occurs even at rest.
• Chronic cough with sputum production, beginning in the morning, and then with time, progressing throughout the day.
• More frequent respiratory infections, including acute chest infections like a bad cold or other infection. These can cause the cough to get worse or result in sputum production that is often yellow-green in color, wheezing, and more shortness of breath.

Diagnosis

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The diagnosis of COPD may be difficult to make since many people have no obvious symptoms. For those who are diagnosed, the symptoms are:

• Chronic cough
• Chronic sputum production
• Shortness of breath with exercise or at rest

Physical examination does not usually show any abnormalities until COPD is fairly advanced. At that point, the findings on examination are: 

• Increased size of the chest cavity
• Decreased breath sounds when a stethoscope is used to listen to the lungs
• Wheezing

Lung function test: Spirometry

For an accurate diagnosis, we may recommend lung function testing, or spirometry. Spirometry is the most accurate way to diagnose COPD because there are other health conditions that can mimic the symptoms of this condition.

Spirometry checks your lung function. It looks at how air flows into and out of your lungs, and how oxygen goes back and forth between your lungs and your blood.

Here it is how it is done: 

• You blow into a mouthpiece attached to a machine (spirometer).
• The machine measures the rate of flow and volume of the air in your lungs.
• We may give you inhaled medication during the test.

Your response to this medication will help us determine if you have asthma or COPD.

The information from this test is much better than a chest X-ray for finding out if you have asthma or COPD. It is also more accurate than using a peak flow meter or listening for wheezing to check your lung function. The results of this test will tell us whether medication will be helpful in treating your condition. It should not take more than an hour of your time.

Pulse oximetry

Before a chest X-ray, your level of oxygen saturation is measured at rest or with exertion depending on your situation. it is used to determine if you need home oxygen therapy.

Chest X-ray

Chest X-ray may be helpful in the diagnosis of moderate to severe COPD.

Treatments

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The treatment of COPD must be tailored to the individual. There are treatments for chronic COPD and treatments for flare-ups of COPD. The goals are to decrease symptoms and to improve your ability to enjoy your life. We specifically want to decrease the possibility of flare-ups and increase your ability to exercise.

Medications

Commonly used medications include:

• Beta-agonists or anticholinergics to help keep your breathing tubes open.
• Inhaled glucocorticoids or corticosteroids to help reduce or prevent inflammation of the lungs.
• Combinations of beta-agonist, anticholinergic, and glucocorticoid medications can also be used to control COPD.
• Oral steroids may be used in severe cases. They can cause problems including thinning of the bones, increase in blood sugar levels, cataracts, and an increased susceptibility to infection.
• Theophylline is rarely used because it is metabolized by the liver, side effects are common, and it interacts with other drugs that you may take.
• Mucolytics or medications that thin or break down mucus are not very effective, so they are not often prescribed.

If you are at risk for heart disease, we may also recommend that you take a statin drug (medication to reduce cholesterol).

Vaccinations are important to prevent flare of COPD:

• Annual influenza vaccine is highly recommended.
• Pneumonia vaccine is advised for all COPD patients.

Other Treatments

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Oxygen. Prescribed for patients with severe COPD who have low oxygen blood levels. It can improve lifespan and quality of life.

Surgery. People with emphysema, mainly in the upper part of the lungs, who have a low ability to exercise, may benefit from lung volume reduction surgery.

Lung transplant. This is reserved for people with COPD with severe symptoms of emphysema due to an inherited disorder called alpha-1 antitrypsin deficiency.

Treatment of Flare-ups

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These episodes are caused most often by exposure to viruses and bacteria. Less often they may be due to an environmental pollutant, and in a few cases, no cause is found. Other medical conditions such as heart problems or blood clots in the lungs called pulmonary emboli may worsen with COPD.

An Emergency Department visit is sometimes needed during a flare-up. The treatment  may include medications and oxygen.

Lifestyle Management

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Quitting smoking is an important part of your treatment. We can help you find resources that will work for you.

It is important for you to stay active in order to maintain and increase your lung function. Comprehensive pulmonary rehabilitation, which includes exercise training, may be helpful to improve ability to exercise, decrease shortness of breath, and increase self-care.

Good nutrition is important. Supplements or appetite stimulants may be needed to increase protein and calorie intake.

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Your Care with Me

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If you are having significant trouble breathing, act quickly. Call 911 emergency services before you call anyone else.

If you have COPD and it is hard for you to breathe, please call our Appointment and Advice line. Trained, experienced nurses are available 24 hours a day, 7 days a week. They can give you immediate advice about what to do. If you want to connect with me directly, they can send me a message or book an appointment with me. 

We urge you to call under these circumstances:

• If you have severe shortness of breath and/or wheezing. 
• If you have a chronic, productive cough that is getting worse.
• If you are coughing up blood.

Based on your symptoms, medical history, and any tests I may order, I will confirm your diagnosis. We will discuss potential lifestyle changes, therapies, and treatment options that are right for you.

If you have difficulty managing your COPD, I may recommend that you work closely with a COPD Care Manager. If you have COPD and you are working with a Care Manager, you may call him or her directly. If you are interested in a referral to this program, please contact me.

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You can connect with me in a variety of ways, depending on the situation and what is most convenient for you at the time. I am available online, by telephone, or in person.

• For nonurgent questions or concerns, you can e-mail me using this site. You can also book an appointment online to see me in person.
• If your concerns are immediate, or you simply prefer to use the telephone, please call our Appointment and Advice line, which is available 24 hours a day, 7 days a week. Our advice nurses can give you immediate advice, and our telephone staff can send me a message or book an appointment for you. 

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How We Coordinate Your Care

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Having all of our Kaiser Permanente departments located together or nearby, including pharmacy, laboratory, radiology and health education, makes getting your care easier for you.

Another major benefit is our comprehensive electronic medical record system which allows all of the doctors and clinicians involved in your care to stay current on your health status and to collaborate with each other as appropriate.

When every member of the health care team is aware of all aspects of your condition, care is safer and more effective.

If you come to an office visit

• At the beginning of your visit, you will receive information about when you are due for your next test, screening, or immunization.  We can discuss and schedule any preventive tests that you need. 
• At the end of your visit, you may receive a document called the “After Visit Summary” that will summarize the issues we discussed during your visit. You can refer to it if you forget what we discussed, or if you just want to recheck your vital signs and weight. You can also view it online under Past Visits.
• To help you prepare for your visit, please see additional details under Office Visit. 

If I prescribe medications

We will work together to monitor and assess how your medications are working and make adjustments as needed. Prescriptions can be filled at any Kaiser Permanente pharmacy. Just let me know which pharmacy works best for you and I will send the prescription electronically in advance of your arrival at the pharmacy.

If refills are needed in the future, you can:

• Order them online or by phone. Order future refills from my home page or by phone using the pharmacy refill number on your prescription label.
• Have them delivered to you by mail at no extra cost. Or you can pick up your medications at the pharmacy. If no refills remain when you place your order, the pharmacy will contact me regarding your prescription.

If lab testing or imaging is needed

For lab tests, I will use our electronic medical record system to send the requisition to the Kaiser Permanente laboratory of your choice. For imaging procedures we will schedule an appointment with the radiology department. When the results are ready I will contact you with your results by letter, secure e-mail message, or phone. In addition, you can view most of your laboratory results online, along with any comments that I have attached to explain them.

If I refer you to a specialist

My specialty colleagues are readily available to assist me if I need additional advice about your condition. In some cases, I may contact them during your visit, so we can discuss your care together. If we decide you need a specialty appointment after that discussion, we can often schedule it the same day or soon thereafter.

If you are due for preventive screenings or tests

As part of our commitment to prevention, additional members of our health care team may contact you to come in for a visit or test.  We will contact you if you are overdue for cancer screenings or conditions which may require monitoring.

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Convenient Resources for You

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My goal is to provide high quality care and to offer you choices that make your health care convenient. I recommend that you become familiar with the many resources we offer so that you can choose the services that work best for you.

My Doctor Online is available 24/7 so that you can access and manage your care where and when it is most convenient. From my home page you can:

Manage your care securely

• View and compose secure e-mail messages.
• Manage your prescriptions and schedule appointments.
• View your past visits and test results.
• View your preventive services to see whether you are due for a routine screening or updated immunization.

Learn more about your condition

• Read about causes, symptoms, treatments and procedures.
• Find interactive health tools, videos, and podcasts to help you manage your condition.
• View programs to help you decide on or prepare for a surgery or procedure.

Stay healthy

• Locate health education classes and support groups offered at our medical center.
• Explore interactive programs, videos, and podcasts that focus on helping you stay healthy.
• View your Preventive Services to see whether you are due for a routine screening or updated immunization.

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